The purpose of the proposed research is the development of an explanatory model of variables associated with prospective adjustment to hemodialysis. Incidence of black patients on hemodialysis is 3.5-fold higher than that in the white population. Although non-adherence to treatment is a serious problem for all patients, drop-out rates are even higher for black patients in urban populations. Previous studies focused on adherence to treatment and quality of life have not reported profiles of persons at risk for deleterious effects of non-adherence and decreased quality of life. This study will examine the relationship of 56 End Stage Renal Disease (ESRD) subjects' self-care self-efficacy to adjustment to hemodialysis at baseline (occasion 1-within 100 days of beginning hemodialysis treatment); 4-months after occasion 1 (occasion 2) and 8 months after occasion 1 (occasion 3). Fifty percent of subjects in the study will be persons who are urban minorities. Independent variables are factors on the self-care self- efficacy measure (Strategies Used by Patients to Promote Health). Dependent variables include: quality of life (Sickness Impact Profile), symptoms (Somatic Symptom Distress Scale), mood states (Profile of Mood States) and adherence to treatment (Compliance perception Questionnaire and objective measures of adherence). Forward stepwise regression will be used in this study. Information gained from this study may be useful in providing empirical knowledge of factors explaining prospective adjustment ot hemodialysis and may facilitate designs of intervention studies.